Wednesday, February 29, 2012

For millennia, sages from the Buddha to Yogi Berra have been advising us to tame our wandering minds and focus our attention on the present. The reason is obvious: The past is history, the future nothing but a dream. All we really ever have is now.

Great advice, but not so easy to follow—especially in our hi-tech, device-ridden world where the tools of distraction are multiplying like ants at a Fourth of July picnic. Here are seven strategies to help you smell the peonies, be present with your loved ones, and savor each moment of your day.

Make it a priority. As anyone who has ever sat down to meditate will tell you, the mind is a devilish, unruly beast prone to fretting over what happened yesterday and what might happen tomorrow. By deciding to focus on the present moment, you are taking the first step toward actually experiencing that moment. And, believe it or not, the instant you realize your mind has drifted (which it will, endlessly) is cause for celebration, and means that you’re starting to pay attention.

Avoid the M-word. Multitasking. Nothing kills the moment (and possibly you) faster than texting and programming your GPS while driving down a highway. Less potentially lethal but equally insidious is Googling something online while talking on your Smartphone and setting a recording on your DVR—when you’re supposed to be spending quality time with your partner. One thing at a time.

Discover the sacred pause. This can take many forms: meditation, yoga, prayer, a walk in the woods, even sitting on the front porch and observing the passing clouds. The Buddhist teacher Thich Nhat Hanh suggests stopping and taking a few deep breaths before answering a ringing telephone. How long you pause matters less than making the sacred pause a regular part of your life. As with strengthening any muscle, learning to live in the moment takes daily practice.

Do something out of the ordinary. There’s nothing like doing something new to capture your attention. Learn a foreign language. Travel someplace you’ve never been. Try your hands at pottery or your feet at tango. You don’t even have to leave your house to shift your focus. D. H. Lawrence said, “I got the blues thinking of the future, so I left off and made some marmalade. It’s amazing how it cheers one up to shred oranges and scrub the floor.”

Forget your to-do list. Most of us, when we start to pay attention to the ramblings of our busy minds, are shocked to realize just how much time we waste constructing our to-do lists, then berating ourselves for not getting everything done. The secret here is to realize that your to-do list is infinite. You will never get to the end of it. Accepting this helps to free up energy so that instead of being trapped in a mental ten-car pileup, you can really taste the food on your plate, feel the afternoon sun on your face, and hear the birdsong at dawn.

Be patient. Though living in the moment may be the key to happiness, it takes time and ten thousand baby steps to begin to wrangle the often fearful, restless mind. Give yourself credit for practicing. As you become increasingly adept at opening to the present without trying to change it, you’ll discover that whether the moment is difficult or joyful, it will pass in a flash—followed by the next moment and the next.

Critically ill people share several common regrets on how they lived their life.

People grow a lot when they are faced with their own mortality. I learned never to underestimate someone's capacity for growth. Some changes were phenomenal. Each experienced a variety of emotions, as expected: denial, fear, anger, remorse, more denial and eventually acceptance. Yet every single patient found peace before departing. Every one of them.

When questioned about any regrets they had or anything they would do differently, common themes surfaced. Here are the most common five:

1. I wish I'd had the courage to live a life true to myself, not the life others expected of me.This was the most common regret of all. When people realize that their life is almost over and look back clearly on it, it is easy to see how many dreams have gone unfulfilled. Most people have not honored even half of their dreams and had to die knowing that it was due to choices they’d made, or not made.It’s important to try to honor at least some of your dreams along the way. It’s too late once you lose your health. Health brings a freedom very few realize, until they no longer have it.

2. I wish I didn't work so hard.This came from every male patient I nursed. They missed their children's youth and their partner's companionship. Women also spoke of this regret. But as most were from an older generation, many of the female patients had not been breadwinners. All of the men I nursed deeply regretted spending so much of their lives on the treadmill of a work existence.By simplifying your lifestyle and making conscious choices along the way, it is possible to not need the income that you think you do. And by creating more space in your life, you become happier and more open to new opportunities, ones more suited to your new lifestyle.

3. I wish I'd had the courage to express my feelings.Many people suppressed their feelings in order to keep peace with others. As a result, they settled for a mediocre existence and never became who they were truly capable of becoming. Many developed illnesses relating to the bitterness and resentment they carried as a result.

We cannot control the reactions of others. However, although people may initially react when you change the way you are by speaking honestly, in the end it raises the relationship to a whole new and healthier level. Either that or it releases the unhealthy relationship from your life. Either way, you win.

4. I wish I had stayed in touch with my friends.Often they would not truly realize the full benefits of old friends until their dying weeks, and it was not always possible to track them down. Many had become so caught up in their own lives that they had let golden friendships slip by over the years. There were many deep regrets about not giving friendships the time and effort they deserved. Everyone misses their friends when they are dying.It is common for anyone in a busy lifestyle to let friendships slip. But when you are faced with your approaching death, the physical details of life fall away. People do want to get their financial affairs in order if possible. But it is not money or status that holds the true importance for them. They want to get things in order more for the benefit of those they love. Usually though, they are too ill and weary to ever manage this task. It all comes down to love and relationships in the end. That is all that remains in the final weeks: love and relationships.

5. I wish that I had let myself be happier.This is a surprisingly common one. Many did not realize until the end that happiness is a choice. They had stayed stuck in old patterns and habits. The so-called “comfort” of familiarity overflowed into their emotions, as well as their physical lives. Fear of change had them pretending to others, and to themselves, that they were content. When deep within, they longed to laugh properly and have silliness in their life again.When you are on your deathbed, what others think of you is a long way from your mind. How wonderful to be able to let go and smile again, long before you are dying.Life is a choice. It is your life. Choose consciously, choose wisely and choose honestly. Choose happiness.

Woman Saves Cat’s Life; Cat Returns the Favor

When Amy Jung of Sturgeon Bay, Wisconsin adopted two cats from a local shelter, she had no idea that, just hours later, the decision would save her life.

Jung wasn’t planning on coming home with a cat, let alone two cats that day. She and her son Ethan had stopped by the Door County Humane Society to play with the homeless felines.

But Pudding, a 21-pound orange and white cat, caught Jung’s attention. The two made a connection and Jung decided to adopt him. Pudding and another cat, Wimsy, were brought to the shelter together when their owner died a month earlier. Jung, not wanting to separate the two cats, adopted them both.

According to Jung, the pair of felines made themselves at home right away and all seemed well.

Until later that night when Jung, who has been diabetic since childhood, went into a diabetic seizure in her sleep.

That’s when the normally laid-back Pudding took action. Jumping on Jung’s chest, Pudding began to nudge and bite at her in an apparent attempt to rouse her. Jung said the heavy cat on top of her woke her long enough to call to her son for help.

When the sleeping Ethan did not hear his mother’s cries, Pudding raced into Ethan’s room and jumped on him, waking him up in time to get medical help for his mother.

Jung and her son are amazed and grateful to Pudding. “If something or someone hadn’t pulled me out of that, I wouldn’t be here,” Jung told the Green Bay Press-Gazette.

Carrie Counihan, Door County Humane Society executive director, described the giant cat as very laid back and relaxed. To jump up on someone like he did to Jung was not his normal behavior, making it all the more believable that he knew something was amiss. "That, for me, makes the story really stand out," she told the Green Bay Press-Gazette. "That he was sensing something and reacting to it."

At the suggestion of her doctor, Jung registered Pudding as a therapy cat. Pudding now sits by Jung’s side and meows if he senses her blood sugar may be low.

Monday, February 27, 2012

When we first learn The Secret it is a defining moment in our life. We realize that everything we have experienced in our life was an effect, and that we caused those experiences through our thoughts and feelings.In one incredible moment we come face-to-face with the fact that we have been the cause of many good things in our life, but we have also unintentionally brought pain and suffering to ourselves. At the same time, we realize that the future is entirely in our hands, that every possibility can be realized, and that we can easily change anything and everything in our life - through our thoughts and feelings.

But this world we live in, with its dazzling special effects of people, circumstances, and events, can be a very distracting place, and if we don't practice what we've learned, the greatest discovery of our lives will slip through our fingers. With the loss of that discovery, our lives will fall back into negativity.

To ensure that this never happens to you, I wrote a new book. It's called The Magic.In The Magic I disclose a piece of life-changing knowledge that is hidden within a two thousand-year old sacred text. Then, on an incredible, 28-day journey, I teach you how to apply this knowledge in your everyday life. If you want your life to touch the stars and be breathtakingly magical, it can be. If you want to change anything in your life, know that there are no limits to what you can change it to... by putting the precious knowledge contained in The Magic into practice!

To read an exclusive preview of the first chapter of The Magic, click here.

Saturday, February 25, 2012

The news that a friend or relative has Alzheimer's disease is not only devastating---it also can be intimidating, as I've heard so often from friends. Most people don't quite know what to say or do when they are with the person. Yet there are specific ways you can stay close with the loved one and contribute to his/her ongoing comfort and serenity, say medical social worker Nancy Pearce, author of Inside Alzheimer's: How to Hear and Honor Connections with a Person Who Has Dementia (www.InsideAlzheimers.com). She offers the following guidelines, which work whether the person was recently diagnosed or is now quite impaired... Decide to connect.Before every visit, think about what might be getting in the way of interacting with this person. Often it's our innermost feelings, such as, This is just so sad or This is too hard. Such thinking distracts us from being truly present. Another obstacle to connection is how you communicate nonverbally. A person with dementia still can feel your tensions, distractions or apathy because these are broadcast through your stance and voice. Before you go into the room, take a moment and breathe deeply to release tension.Let go of rigid thinking, and think about what is best for the person. Case in point: Pearce once worked with a 92-year-old man who every day anxiously asked for his mother---and every time was told that she had died. Each day, he grieved anew. His caregivers meant well, but their concern with accuracy actually was cruel. When his caregivers realized what really was behind the request---the need to feel taken care of---they were able to make the patient's life much more peaceful. For example, when he wanted his mother to do something for him, his caregivers let him know that she could not be there at that time, but that they would help him instead.Open you heart and enter the person's world, rather than getting caught up in the nuts and bolts of the disease by asking about symptoms and so on. Pearce knew a man with dementia whose longtime golf buddy picked him up every week to play. When the man could no longer hit the ball, his friend found other things for him to do at the golf course---drive the cart or clean the balls---so they still could happily share their mutual interest. There was another woman whose be-loved grandmother had Alzheimer's, and as a result, the grandmother often was angry. After much trial and error, the woman learned that what opened both their hearts was to watch old movies together.Embrace silence. When it comes to talking, less can be more, especially for people who may be frustrated about losing their ability to speak and comprehend. You don't have to fill every silence with conversation.Express gratitude. No matter how advanced the disease, notice and thank the person for all the little things you appreciate about being with him. You might simply thank him for allowing you the time spent together.

March is the official National Optimism Month. When negative thoughts intrude, switch to positive ones. Focus on finding solutions instead of obsessing about problems. Write a daily summary of the good things that happened or the things you have to be thankful about. Chances are you may have more to be thankful about than you realize!

Friday, February 24, 2012

Here are favorite quotes, straight from Oprah herself - mini-lessons you can take with you anywhere.

Lesson 1: The False Power of Ego﻿

"What I know for sure is you can't even begin to love yourself or even be true to yourself unless you know who you really are---separate from your ego."

Lesson 2: The False Power of Ego

"[The ego is] an impostor, imposing on the real you, making you think that you're something that you're not."

Lesson 3: Letting Go of Anger

"One of the best lessons for me is learning that revenge is another way for the ego to show itself."

Lesson 4: You Become What You Believe

"Do you believe that you are worthy of happiness? Do you believe that happiness, success, abundance, comfort, fulfillment, peace, joy, love is a part of your birthright? Or do you believe something else? Because you will manifest the life that you believe."

Lesson 5: The Truth Will Set You Free

"If you are in any way keeping a secret, or if you are in any way pretending to be something that you are not, you will never become all that you were meant to be. It just cannot happen."

Lesson 6: Everybody Has a Calling

"Sometimes the calling is something that was just a whisper to you and when you begin to honor that whisper and to follow that, you end up being the best that you can be."

Lesson 7: Aging Beautifully

"When you lie about your age you are denying that part of your life. You are denying energetically the years that you have earned here on the planet Earth. ...You are denying your very existence."

Lesson 8: When You Know Better, You Do Better

"Do you know how freeing those words are? How freeing they can be for you? What it means is you don't have to hold yourself hostage to who you used to be or anything you ever used to do."

Lesson 9: You're Responsible for Your Life

"If you're sitting around waiting on somebody to save you, to fix you, to even help you, you are wasting your time because only you have the power to take responsibility to move your life forward."

Lesson 10: When People Show You Who They Are...Believe Them

"When somebody has shown you who they are, believe them. Stop expecting them to be something other than who they are. Believe them. And move on."

Lesson 11: Listen to Your Gut

"Your gut is the voice of your higher self. It's your personal GPS system to guide you and to try to keep you out of danger's way. Out of harm's way. That is the gift of fear."

Lesson 12: Do Your Eyes Light Up When Your Child Walks in the Room?

"Most of the arguments that you have had in your life have not been about the specific thing, but they've been about what is behind the thing that you're arguing about...And if you peel back the layers, what is usually behind the things that we're arguing about is, Do you hear me? Does what I say mean anything to you? Do I matter? That's what everybody is looking for."

Lesson 13: Step Out of the Box

"If you want something you never had, you've got to do something you've never done."

Lesson 14: Love Doesn't Hurt

"Your relationship with your spouse, with your family, with your friends all can change if you get this lesson that took me to my late 20s, probably mid-30s to actually fully realize: Love does not hurt."

Lesson 15: Love Doesn't Hurt

"When you trust yourself, it means you don't tolerate being stood up more than one time. ...You don't tolerate chronic betrayal."

Lesson 16: Love Doesn't Hurt

"When you can trust that you love yourself, care for yourself, have enough honor and respect for yourself that you will not allow other people to harm you, then you can succeed in any relationship...It doesn't mean that somebody won't hurt you again. It means that when they do, you will know what to do...You will not let that destroy you."

Lesson 17: Love Doesn't Hurt

"Love is truth. Love is grace, is joyful."

Lesson 18: Slow Down

"Being in the present moment ---if you can learn to do that, it begins to change your whole life."

Lesson 19: Newton's Third Law

"If there are a lot of negative people in your life, don't look at them, look at the energy that you are creating to attract them. Don't look at them, look at yourself."

Lesson 20: You've Always Had the Power

"The only courage you ever need is the courage to fulfill the dreams of your own life."

Friday, February 10, 2012

﻿There is one little habit I’ve learned that has changed everything else in my life.

The pause.

When we fail, it’s because we act on urges without thinking, without realizing it. We have the urge to eat junk, and we do it. We have the urge to check email instead of writing a chapter of our book, and so we open our inbox. We have an urge to smoke, to drink, to do drugs, to chew our nails, to play a Facebook game, to procrastinate, to skip a workout, to eat more fries, to criticize, to act in jealousy or anger, to be rude … and we act on that urge.

What if instead we learned to pause after each urge? What if we stopped, looked at that urge, paid close attention to what it feels like inside our bodies, but didn’t act? The urge would no longer control us. We would be able to make conscious choices that might be healthier for us, help us be happier. If we can pause, we create space. Space to breathe, to think, to be without acting. The pause is the answer to so many of our problems. Such a small thing, and so powerful.

To develop the pause, notice your next urge. Is it an urge to go check something online? Or eat something you know isn’t healthy for you? Pay attention to the urge, learn as much as you can about it. If you act on it after the pause, that’s OK. Just notice it, and pause, and pay attention.

Do it again for the next urge, and the next. You will get good at it with practice, and you’ll have lots of opportunities to practice.

The urges won’t go away, but your ability to pause will get stronger. And when you have the pause, you have everything.

Wednesday, February 8, 2012

Suffering from depression is very different from being sad. Sadness is a normal part of life. Depression is a constellation of psychological and physical changes that persist, unrelenting, for a minimum of two weeks -- and often much longer.One of every eight women and one of every five men will suffer at least one bout with serious depression at some point in their lives. Genetics seem to predispose some people to depression, though life events can be a factor as well. Seniors who experience losses in physical functioning and social networks can be especially susceptible to bouts of depression.For those affected, depression often becomes an ongoing issue -- those who have faced it once have a 40% chance of experiencing an episode in the future and those who already have had multiple episodes face up to an 80% chance of additional recurrences.Depression is most commonly treated with medication that regulates the brain’s chemistry and with professional counseling, which helps people take effective action in the face of the low motivation and pessimism that often define depression.Exciting new tool: In the last decade or so, a new technique has been shown in studies to help sufferers head off depression before it takes hold. The technique is called mindfulness -- paying attention to the present moment, without judgment, in order to see things more clearly.

LIFE ON AUTOMATIC PILOT

Mindfulness can prevent depression from taking hold of us because the alternative -- our usual state -- is that we operate on “automatic pilot.” Our minds are elsewhere as we perform mundane activities. Example: You’re taking a shower, but wondering what’s waiting in your e-mail.If we let it, this automatic pilot also will select our moods and our emotional responses to events -- and the responses it chooses can be problematic. For instance, if you make a minor misstep in some area of your life, your autopilot might select as your emotional response feelings of anger, failure and/or inadequacy, even though the event might have been completely inconsequential.Because your mind is not paying full attention to the situation, you might not grasp that the negative feelings are greatly out of proportion to what’s really going on. You only know that you feel bad. When these negative feelings persist, they can pull you into the downward spiral of depression.Example: A friend mentions that one of the stocks in his portfolio has turned a profit. Your investments have not been as successful, and your autopilot selects inadequacy as your primary emotional response. This may sound like an overreaction, but in someone who is prone to depression, these feelings can expand into a full-blown episode.Mindfulness can be an antidote to automatic pilot. By becoming more aware of the world around us, we experience life directly, not filtered through our minds’ relentless ruminations. We learn to see events for what they are rather than what our autopilot might turn them into. That helps us to derail potential episodes of depression before they have a chance to take hold. It typically takes two weeks or longer for depression to fully sink in, so there is often plenty of time to stop the process.

BECOMING MINDFUL

Learning to be mindful involves more than simply paying attention. You must reorient your senses so that you experience a situation with your whole mind and heart and with all of your senses.Try it out: Pick up a raisin. Hold it, feel it, examine it as if you had never seen anything like it before. Explore the raisin’s folds and texture. Watch the way light shines off of its skin. Inhale its aroma. Then gently place it on your tongue. Notice how your hand knows exactly where to put it. Explore the raisin in your mouth before biting. Then chew once or twice. Experience the waves of taste and the sensation of chewing. Notice how the taste and texture change as you chew. Once you swallow, try to feel the raisin moving through your digestive system.Keep it up: Practice the following three steps every day to make mindfulness a regular part of your life -- and episodes of depression less likely...1.Focus on your breath. Focusing your attention on your breath is perhaps the simplest, most effective way to anchor your mind in the moment. You think only of this breath. You can do this anytime, anywhere.2.Watch your thoughts drift by like clouds. See them, acknowledge them, but do not attempt to reason them away. Some people attempt to use logic to escape depression. They tell themselves, My life is pretty good -- I should be happy. This just leads to troubling questions like If my life is good, why am I so unhappy? What’s wrong with me?It is also tempting to try to push negative thoughts away so that you don’t have to deal with them at all. Unfortunately, the thoughts are still there even if you refuse to acknowledge them.Better: When you feel bad, reflect on what is bothering you. Try to uncover the original thought or event that set off your bad feelings. Then view it as just a thought, something independent from you even though it has popped into your head. Do not dismiss it, though. Even if the thought or the event that caused it was trivial, the feelings it has prompted are real and significant.Next, notice any physical sensations that you are experiencing. Does your throat feel tight? Is your mouth dry? Are there butterflies in your stomach? Just as you are learning to watch your feelings float by, watch these physical sensations in a detached way. If you can learn to spot the onset of these sensations, you will be able to identify the early signs of depression sooner -- and head off the bad feelings before they take root.3.Take action. Ask yourself: Does this thought have any merit? Is it connected to negative thoughts that I have had in the past? What can I do to make myself feel better about this issue?Example: You feel depressed about your work life even though you are doing fine in your job. When you reflect on these negative thoughts, you realize that they began recently, when you learned that your brother received a promotion. You feel left behind because it has been some time since your last promotion.What actions could you take to allay these negative feelings? Perhaps you could speak with your supervisor about your job performance and your prospects for future promotions... or contact a headhunter to remind yourself that you have other options.With any problematic thought, identifying it quickly and taking some positive action is often enough to head off depression.Important: Learning the mindfulness approach can be useful for preventing future bouts of depression -- not for combating an episode that is already under way. When people are in the midst of depression, they typically cannot concentrate sufficiently to practice mindfulness. It is better to use the technique between episodes of depression so that it becomes a natural part of your thought process.

WHERE TO FIND HELP AGAINST DEPRESSION

For information about depression and links to local support, contact...

Tuesday, February 7, 2012

Fear, anger, guilt--caring for a loved one can take a toll on you, too. Gail Saltz, MD, helps you work through the emotions.

You know the saying, "If the plane is losing oxygen, put on your own mask first, then your child's." If you're caring for a loved one, this applies to you, too. But with over half of caregivers reporting that they're eating poorly and not exercising and three quarters not going to their doctors regularly, it seems that most of them have abandoned their own oxygen masks. And understandably so: Though taking care of a love one can certainly be fulfilling, there's no denying that it's emotionally taxing.

So what can ease the strain?

Recognizing and acknowledging your feelings about the issue--I've listed the three most common emotions below-- is the first step. Then, understanding what's behind your emotions can help lessen the stress they cause.﻿

1 - You resent the responsibility

No matter how much you love the person and truly want to take care of him or her, it's inevitable that you'll feel frustrated--even angry--about how much of your life you're giving up and how hard the task is. Having outlets for "me time," such as friends to talk with, will help keep resentment manageable. Set aside 30 minutes each day to do something for yourself--whether it's exercising (which also helps you feel less stressed, since it prompts your body to produce feel-good endorphins), watching a funny TV show or listening to music. Also, pick a favorite habit or part of your routine from your "before" life to keep in your life now. It can be as small as taking the time to read the paper while you eat breakfast.

2 - You're grappling with your own mortality

Taking care of someone who's sick inevitably brings up questions like

What happens if my mother/father/sister/aunt doesn't get better? Will the same thing happen to me one day, and who will take care of me? As normal as these thoughts are, they're upsetting. To help you work through them, keep a journal/notebook to write down your thoughts and fears daily or every few days. This can help you realize that you're nowhere near being in your loved one's shoes. Doing things you're enthusiastic and passionate about and being present in the moment, such as taking extra time to enjoy your morning coffee--how it smells and tastes--also helps draw a contrast between the two situations and reinforces the fact that you're in a very different stage of life.

3 - You feel guilty

As a caregiver, you're making so many important, life-changing decisions that it's all too easy to second-guess yourself. Did we choose the right nursing home? Did I spend enough time with her today? Accept that feeling like this is normal and in no way means you're a bad person, and you'll help keep guilt at bay. Guilt is what tends to make people depressed and anxious; they may even unconsciously do things that are self-destructive to "punish" themselves.

Another key to combating guilt is to pinpoint what you feel guilty about. This can help you understand that some things are just out of your control like the fact that your loved one is sick. Sit down with pen and paper and ask yourself, What makes me feel guilty? and write down everything that comes to mind. For each point, ask Can I do something about this? Am I being reasonable? For example, you may feel guilty about taking time for yourself--but that's one of the most important things that enables you to be a good caregiver.

Caring for a sick loved one is a tremendous responsibility. All you can ask of yourself is that you do your very best--without sacrificing your own health and well-being.

Gail Saltz, MD, a psychiatrist and psychoanalyst, is a clinical associate professor of psychiatry at the New York Presbyterian Hospital and a TODAY show contributor.

This article appeared in the March 2012 issue of Woman'sDay

* Signs that you need a break:

New health problems are often the first warning that caregiving is taking a serious toll. Red flags that you should see a doctor: an increase in blood pressure, headaches, back pain, constant fatigue, substantial weight loss or weight gain, sleeplessness and repetitive colds or viruses.

Signs of depression that call for a visit to a mental health professional:

A change in sleep and appetite, feeling hopeless and helpless, pervasive feelings of guilt, not being able to enjoy any activities, often feeling nervous, nausea, shortness of breath and thoughts of suicide.﻿

Richard Laliberte is an award-winning health and medical writer whose work has appeared in The New York Times Magazine and other publications.

Sixty-five million Americans are taking care of a loved one. Chances are, you--or someone you know--will be one of them at some point. What everyone needs to know to manage it all.

The day I flew home after Dad died, I found Mom in a state of confusion. Her dementia had not yet progressed to the point where she needed care in a facility, but when the family brought in full-time caregivers to help with Dad, we all realized Mom couldn't be left alone in the house, either. I stayed in her room that night, bunking awkwardly on Dad's hospital-style bed, hoping Mom would feel less alone. Sitting with me before she turned in, she tried to grasp the implications of Dad's death. "What will I do?" she said.

It was the beginning of a long road that started with new round-the-clock hired caregivers. Over the next eight years, as her cognitive abilities declined, Mom moved in with my sister and her family until the strain on the household became too great. She then went to an assisted living unit and eventually entered the nursing home where she lives today.

My siblings who lived near her took primary responsibility for everything--from her immediate care to selling the house--while I mainly watched guiltily from a 1,000-mile distance. But sitting with her that night, trying to be reassuring and focused on the now, I had no idea what lay ahead.

"There's a continuum of ways people become caregivers. Often a loved one suffers a stroke, accident or fall or a chronic condition worsens, and people are thrust into a situation. But few plan for it as well as they could," says Leah Eskenazi, director of operations and planning for the Family Caregiver Alliance: National Center on Caregiving.

As Americans become older and live longer, more and more of us are suddenly finding ourselves in the situation. The number of adults helping a parent personally or financially has tripled in the past 15 years, according to a recent study by MetLife, the National Alliance for Caregiving (NAC) and New York Medical College. Most caregivers (66%) are women in their late 40s caring for a mother or other female relative, but some 14% help another adult age 49 or younger. All told, an estimated 36 million U.S. households have at least one person who's a caregiver, and 3 in 10 of them have been doing it for more than five years.

Inevitably, the demands take a physical and emotional toll, and caregivers are more likely to say their health is fair or poor. Yet caregiving does have its rewards. "It can actually improve relationships with parents, create positive memories and foster peace of mind," says Eskenazi. "The challenge is to maintain balance and not not lose track of your own needs." To help you do that, read on to learn how to navigate the common caregiving milestones so you'll be prepared for what might happen before it does.

"IS everything OK?"****

Adult children often don't realize aging parents need care until a family get-together. "I call it the holiday eye-opener," says Larry Minnix, president and CEO of LeadingAge, an advocacy organization for aging adults and their caregivers (formerly the American Association of Homes and Services for the Aging). "It's often when the family's together in one place that everyone realizes Dad isn't remembering things or Mom's house has become unusually unkempt." Trouble signs: food spoiling in the refrigerator, always finding parents dressed in the same clothes, stacks of papers or mail, left-on appliances like a stove, and an unusually messy house or yard--which can suggest problems handling everyday tasks.

Talk with your parents about medical and financial issues. A good first step is to ask them for a list of all the medications they're taking and their doctors' contact info. Then you can segue into the tougher questions such as living wills and healthcare proxies. "I finally said to my parents. 'If something happens, I have no information to go on to carry out your preferences, so I would like us all to sit down and talk,'" says Eskenazi, a social worker by training.

Other crucial questions include where they keep important papers and whether they have a safe deposit box. They should also sign release forms allowing doctors to share private medical information with you. And your family needs to work out who should have power of attorney if your parents are unable to make competent decisions for themselves.

Ask the doctors to give an overview. If your family memeber is diagnosed with a condition, find out their prognosis and what's involved. Many diseases like Alzheimer's, Parkinson's and cancer can follow a predictable arc, but even if they don't understanding the likely progress of the disease helps you plan ahead.

Evaluate whether they can stay in their home. "The vast majority of people want to age where they've always lived," says Gail Gibson Hunt, CEO of the National Alliance for Caregiving. Basic safety measures can go a long way toward making that possible:* Install grab bars in bathrooms and showers, and put raised seats on toilets.* Turn down the water heater temperature to avoid scalding.* Get rid of tripping hazards such a throw rugs and power cords.* Put brighter bulbs into lamps, especially in walkways.* Place no-slip adhesive strips on steps and slippery surfaces such as bath tile and shower floors.* Suggest a wearable alarm with a button to call for assistance.

For guidance on assessing what help your loved one needs, go to Caregivers Library.org for a needs assessment worksheet and in-home care options.

Be realistic about your ability to help out. For example, if a parent needs to be lifted and you have a bad back or can't be with him all day, you may need to hire help. To find an agency that provides skilled workers, go to the National Association for Home Care & Hospice at nahc.org and type your city and state into their Agency Locator. (Agencies screen and often train carefivers who may be covered by Medicaid or long-term care insurance.)

You can also privately hire a caregiver, which can be less expensive, since you eliminate agency fees (but you may have to pay their employment taxes; check with your accountant). Networks of friends, neighbors and religious or community organizations like the local senior center, YMCA or Jewish Community Center (JCC) are good sources to help you find reliable, skilled caregivers. Your local Area Agency on Aging can give you an idea or going rates.

"Why don't you move in?"*****

Having the person you're caring for move in can work fabulously. But think carefully about taking someone far from her community. "Knowing friends, neighbors and people in the area can be important," Eskenazi says. * "Someone with no network becomes totally dependent on you for physical demands and for all the social and emotional aspects of his well-being."

Figure out how well your loved one can function day-to-day. A healthcare professional can assess her based on nationally recognized criteria know as IADLs - instrumental activities of daily living. (Ask if your insurance pays for an evaluation.) Documenting how much assistance she needs to bathe, dress, eat, walk, use the toilet and handle activities like shopping, laundry or taking medication can help gauge whether or not you can take care of your loved one in your home and her eligiblity for services. For example, someone who qualifies for nursing home care may be able to get services that help him stay in his own home from a program called PACE (Program of All-Inclusive Care for the Elderly), available through Medicare and Medicaid in some states.

For an overview of resources in your area, click on your state on the Family Caregiver Alliance's Family Care Navigator at carefiver.cor. The site also answers common questions such as how to get help when you need a break or how to take time off work to care for a loved one.

Map out the physical and emotional factors. Questions to consider: Where will your loved one sleep? Can you set up her own living space so she'll have some privacy or independence?Given your past relationship, can you get along? Can you both accept that you're the boss? Are you comfortable handling personal care like bathing or changing an adult diaper?

Include the care receiver in the conversation as much as you can. Does she really want to live with you? And be sure to gauge the impact on your family. "If a teen is asked to give up a room so Grandma can stay, there may be issues to address before she moves in," Eskenazi says.

Come to an agreement about who pays what. Go over questions such as" Will a parent help pay living expenses? Will siblings pitch in? Which cost are shared and which ones will you pay out of pocket? Also work with your other family members to create a schedule that allows for periodic breaks, and figure out who will care for your loved one when you go on vacation or have to deal with an emergency.

"We need to consider a home."*****Not everyone can accommodate a live-in loved one. And many who do it initially find that it becomes too overwhelming. "There's a realization that this is beyond what you signed on for," says Hunt. A caregive who's persistently depressed (unable to get out of bed, feeling hopeless and sad on most days) is one sign that it's time to find a new arrangement. Other indications: "The ailing person no longer recognizing you or becoming incontinent are often tipping points, " says Eskenazi. Before starting your search, you, your lived one and family members involved should sit down with a financial advisor to discuss what funds you have and how long they'll last.

Check the Eldercare Locator from the U.S. Administration on Aging(eldercare.gov; 800-677-1116).Searching by the type of service you need and your zip code will provide a list of agencies (such as your local Area Agency on Aging) that can help you find and evaluate local facilities. If the person you're caring for is on the younger side, try starting with the local United Way, which can help sor through services available in their community.

A quick guide:Continuing care retirement communities work like insurance policies: Residents buy in when they're healthy, often make a large payment up front and then pay a monthly fee. People live independently in an apartment, but assisted living and nursing services are available.

Assisted living facilities help residents with daily living but don't give medical care. Generally, people get their own apartment and have access to a communal meal plan and group activities. Many facilities have special wings for people with dementia.

When choosing a facility, as a lot of questions. Talk to administrators and workers who actually provide care. "Ask if the facility has its own staff of nurses and healthcare providers," Minnix says. "If they rely on rent-a-nurses or other outside agencies, that's not a good sign." Look for a staff turnover rate below about 30% and key leaders (such as the administrator and director of nursing) who've been in place for at least several years, he suggest. Also ask: Who owns the facility? Often nursing homes have a donor-funded endowment or are supported by a larger organization such as a religious institution, which tells you others stand behind the facility.What are the costs? Are there upfront fees and/or monthly fees? What services can be added on later? How do you handle emergencies? Some facilities take their residents directly to one specific hospital; others have trained medical staff on site. What happens if you run out of money? Medicaid usually kicks in when resources are depleted, but it may not cover all services.

Take mental notes on what you see. Are people having fun? Is there a lot goin on? Is the dining service appealing? Can you see yourself and/or your kids enjoying a visit there? "There's a stigma against senior housing, but often when I visit assisted living or new facilities for continuing care, I think, 'I want to move in here!' There's a full roster of social activities, art and exercise classes, transportation for shopping," says Joe Buckheit, founder and president of agingcare.com, an online support community for caregivers. "Caregiving involves many important life-changing decisions. Caregivers and their families need to explore as many options as they can to figure out what works for everyone."

where to find help**************

Eldercare Locatoreldercare.gov; 800-677-1116Call or type your zip code or city online to search for services in your community.

Family Cargiver Alliance:National Center for Caregiving caregiver.orgClick on your state on the Family Care Navigator map to locate government,nonprofit and private services in your area.

LeadingAgeleadingage.orgFeatures a search function that helps you find care facilities that offer a variety of services in your area.

Lotsa Helpling Handslotsahelpinghands.comPeople who ask, "How can I help?" can sign on to a Web-based community you create that matches volunteers with tasks and keeps members informed of everything that's going on with the person who's being cared for.

Nation Alliance for Caregivingcaregiving.orgOffers a wise range of research, information and resources--such as a questionnaire that helps you assess your own health.

SNAP for Seniorssnapforseniors.comSearches for senior facilities using a variety of criteria such as type of home, apartment size, memory care services and payment options.

Visiting Nurse Associations of America vnaa.orgClick on your state to find at-home help.

The previous information appeared in the March 2012 issue of Woman'sDay.

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